High pulse pressure, normal BP.

[is_something_wrong]

Hello to the great guys at the Heart Disease Community! :) Posting a question here because it doesn't concern heart rhythm.

I get strange blood pressure readings. Not like the "normal" 120/80, I get readings like this:
115/55, 110/60, 100/48, 120/60, 105/50. With high stress levels I can get slightly high systolic readings (usually 130s) but diastolic is always normal or low.

I know my heart is strong and pumps a lot of blood. Last echo revealed a stroke volume above 100 ml and an EF of 75-80%. I have a fairly slow resting heart rate (45-50 in the morning). I have some PACs but I've learned to live with them.

What could be the reason? High stroke volume causing large pulse waves? Anxiety while measuring? (I tend to be a bit stressed and anxious to get the results). Stiff arteries (at my age)?

Any thoughts?

[kenkeith]

We agree that an increase in volume will increase the ejection fraction according to Frank/Starling's Law that describes the relationship between end-diastolic volume and stroke volume. It states that the heart will pump out whatever volume is delivered to it. If the end-diastolic volume doubles then stroke volume will double. So a parameter that increases volume will increase blood flow and the stroke volume is increased with an increase in contractility.  Higher EF stronger contractility. The converse is true a reduction in volume the lower the contractility and lower stroke volume.  Your question seems to be addressing the control factors to maintain integrity of a balance of blood flow between the left and right side of the heart.... Any exertion will be a additional burden to the heart to supply more oxygnated blood to the muscles and that would be a difference in heart rate, blood flow, EF, etc. and that could explain the difference. HR with exercise of 140 includes blood to muscles, etc,  and HR 140 when anxious would/could be more serious indicating some pathology to meet an oxygenated demand to vital organs. etc.

It seems the controlling factors of hemodynamics are a dilating and constricting vessels for blood volume. The mechanism is in part the endothelial cells that line the inner layer of the vessel. For  more detail I quote: " Normal functions of endothelial cells include mediation of coagulation, platelet adhesion, immune function, control of volume and electrolyte content of the intravascular and extravascular spaces".

Also, there is a CNS factor when the SA node of the heart is enervated by both sympathetic and parasympathetic nerve fibers and anxiety can increase the heart rate and effects are the same as  exercise mode. Under conditions of physical or emotional activity sympathetic nerve fibers release norepinephrine, which acts to speed up the pacemaker potential of the SA node thus increasing heart rate, etc.

You are welcome to the forum at anytime and thanks for the question.  Take care,

Ken

[is_something_wrong]

Hi Ken, thanks for answering. Thanks to jrbon too!

To your comments, no I didn't have LVH, but anxiety levels were high during examination and the heart was pounding, which may of course have affected the EF. Maybe I'm a bit anxious while measuring the blood pressure too. I guess I don't like to see the "hard facts" about my body/heart. Possibly because I understand most of them too well...

I'm most active on the Heart Rhythm Community (I'm a co-CL there) but it's nice to visit you at the "sister community" Heart Disease too! Many of you are really qualified and you provide excellent answers.

PS: About the stroke volume/heart rate. That seems correct, unless during exercise, of course. I see many people are afraid of the weak pulse and dizziness they get with panic attacks, when standing up too quickly, etc. When you don't use the muscles and get sufficient venous return, EF will fall. It's not the same to have a HR of 140 during jogging, as to have a HR of 140 during anxious times, I think.

Thanks again!

[kenkeith]

It is difficult to assess any irregularity of the cardiovascular system because the hemodynamics change with medication, etc. The last echo revealed a stroke volume above 100 ml and an EF of 75-80% and that would be a snapshot at the time of the test.  An estimated EF greater than normal (70-80) and consistent can indicate hypertrophy of the left ventricle.  When the heart dilates the contractility is increased but may become pathological if the underly cause for the dilation increases.  EF is a compensating factor and helps maintain a balancing flow of blood between the right and left side of the heart.  Stroke volume is inverse to the heart rate.  Slow heart rate the greater the stroke volume which indicates the heart rate is also a compensating factor...the slower the heart rate the more time to fill.

Wide pulse pressure (no medication, etc) can be the outcome of increased CO due to fitness, anxiety, hyperthyroidism, etc.  Also, a wide pulse pressure can be seen in athletes. If you had a stress test the EF should increase slightly as well   And as you state stiff vessels can be the cause but that condition is usually reserved for older generation, but not always.

Hope this helps,  

Ken

Are you referring to the newsletter regarding HD?

[jrbon]

As I understand, a pulse pressure of above 60 it is indicative of stiff arteries, so some of your readings seem to be border line, however this is when you take your BP on a relaxed situation not an stressed one.

Since I see that you live in Oslo, I would check the Vitamin D values in  blood. You should aim at 60ngr of 25-hydroxyvitamin D.

Jesus.